ParentApp for Teens in Tanzania Updates

The study is a two-arm pragmatic cluster randomised controlled trial of ParentApp for Teens - an offline-first, open-source mobile app version of the in-person Parenting for Lifelong Health for Teens parenting programme. It aims to compare the effectiveness and cost-effectiveness of hybrid digital delivery of ParentApp with WhatsApp group support, with an attention-control group who will receive a WASH app. The study will be conducted amongst low-income families with adolescent children aged 10 - 17 years in Tanzania.

2024

The ParentApp for Teens team has made considerable progress in their fieldwork and analysis activities. Qualitative interviews with caregiver, adolescent and intervention facilitator participants for the cluster ParentApp randomised controlled trial (RCT) are now complete (n=67). Interim analysis of the cluster RCT 1-month post-test data show significant impact across the majority of primary, secondary and exploratory study outcomes. The intervention also had an unexpectedly high engagement rate of 75-97% module completion, with ongoing engagement post-intervention. The team plans to explore potential explanations for retention rates through further qualitative work. In addition, costing of ParentApp delivery at scale is complete and a costing template for external use has been developed to support uptake of the ParentApp programme in other countries and contexts. 

12-month follow-up surveys for the ParentApp for Teens Optimisation study began on 11 June with an expected completion date of December 2024. Cost-effectiveness analyses are also ongoing and will be finalised post 12-month RCT follow-up. Finally, interviews were completed in June for the sibling exploratory study (n=2,016). Addressing feedback that ParentApp was being accessed within the wider family unit, this study is a novel approach that aims to explore the potential spillover effects of ParentApp intervention on other children (aged 10-17) within the household. As of late June, descriptive data is available and analysis is ongoing. 

With regards to dissemination, team members have accepted abstracts confirmed for three presentations at the Sexual Violence Research Inititiave Forum (21-25 October, Cape Town). Members of the ParentApp for Teens team have also presented at the following conferences and events:

  • Karolinska Institutet UNICEF Joint Conference on Global Child and Adolescent Mental Health (15-16 May, Stockholm)

  • The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) annual meeting (20-24 May, Rio de Janeiro)

  • International Society for the Study of Behavioural Development Conference (16-20 June, Lisbon)

  • RIATT-ESA Regional Learning and Linking Forum (25-26 June, South Africa)

  • Department of Social Development Roundtable on Linking Social Protection Beneficiaries to Sustainable Livelihood Opportunities (June, South Africa).

ParentApp for Teens fieldwork and implementation activities continue to progress well. The one-month randomised controlled trial (RCT) follow-up survey concluded in March with a total of 2,327 (97%) caregiver interviews and 2,252 (94%) teen interviews covering 80 clusters (n=2,396). The 12-month feasibility pilot follow-up survey has also been conducted with 100 caregivers and teens and interviews have been completed with 88 caregivers (88%) and 81 teens (81%). Tracing remaining participants took place during April with a dedicated team of four Research Assistants to ensure comprehensive engagement with all study participants who could be reached. Qualitative interviews with RCT participants also continue. As of mid April, Interviews have been conducted with caregivers and intervention facilitators, marking a promising start to engaging these groups. Data collection for the sibling exploratory study, which is focused on adolescent siblings aged 10-17 years or co-residents with an index teen from both intervention and control arms of the main RCT, began on 6 April and is expected to conclude by early July. As of mid April, A total of 504/2,610 sibling interviews (19.3% of the initial sample) have been completed, reaching 242 males and 262 females across seven clusters.

Phone onboarding has concluded in all clusters, and all clusters have completed the 12 weeks of app engagement/live chats. Of the 1,195 intervention-arm participants who completed one-month follow-up, 861 have successfully unlocked the new content. The research, implementation and IT teams are working together to trace and troubleshoot access challenges with the remaining 334 participants. A WhatsApp community has also been created for announcements and engagement boosting activities. Participants who have left WhatsApp groups have been added to a WhatsApp broadcast list so they can also receive messages should they wish to.

With regards to policy engagement, a multi-sectoral parenting group (MSPG) meeting took place in Dar es Salaam, Tanzania, marking a significant step forward in parenting policy scale up collaborative efforts. During this meeting, representatives from the Ministry of Community Development, Gender and Children and the National Institute for Medical Research (NIMR) presented the proposed work plan to the MSPG members and successfully finalised the terms of reference for the group's operations. Currently, an ongoing effort is underway to monitor the parenting policy environment, ensuring that developments are closely tracked and analysed.

Concerning research dissemination, the ParentApp for Teens team have accepted abstracts confirmed for presentations at the following conferences in 2024:

  • Karolinska Institutet UNICEF Joint Conference on Global Child and Adolescent Mental Health (15-16 May, Stockholm)
  • The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) annual meeting (20-24 May, Rio de Janeiro)
  • International Society for the Study of Behavioural Development (ISSBD) 27th Biennial Meeting (16-20 June, Lisbon)
  • International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Conference (18-21 August 2024, Uppsala)

The ParentApp for Teens team has made considerable progress with their current fieldwork activities, a one month randomised controlled trial (RCT) follow-up and 12 month feasibility pilot follow-up. As of 29 February, a total of 2,281 caregiver interviews (95%) and 2,081 teen interviews (87%) have been successfully completed, covering 80 clusters (N = 2,396). Qualitative interviews with RCT participants and programme implementers are also ongoing. To date, 1 focus group with participants and 6 in-depth individual interviews have been held with programme implementers. Planning is also underway for a sibling exploratory survey with select RCT households, due to begin in April. Ethics amendments are approved in Tanzania and preparation of a data collection tool in progress, which the team aims to finalise in the second week of March. Phone onboarding was completed in 80 clusters (N = 2,387). All clusters (intervention and control) have completed the 14-week intervention period (12 weeks of app engagement/live chats + 2 weeks of catch-up). In the intervention group, on average, engagement in WhatsApp group live chats was 70%. Engagement with ParentApp modules was ≧ 80% for all 12 core modules. 629/890 caregivers (70.7%) also accessed additional modules. 

With regards to dissemination activities, members of the ParentApp for Teens team have submitted abstracts for the following conferences in 2024:

  • The 2024 International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) annual meeting (20 - 24 May, Rio de Janeiro)

  • Society for Prevention Research (SPR) Annual Meeting (28 - 31 May, Washington)

  • International Society for the Study of Behavioural Development (ISSBD) 27th Biennial Meeting (16 - 20 June, Lisbon ) 

  • International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Conference (Sweden, 18 - 21 August 2024). 

  • The Sexual Violence Research Initiative (SVRI) Forum (21 - 25 October, Cape Town)

2023

Following the successful completion of baseline data collection for the randomised controlled trial (RCT), the ParentApp for Teens team is making good progress with one-month follow up activities. 1434/2396 (60%) caregivers and 1367/2396 (57%) teens have been interviewed as of December 2023. Regarding implementation, a total of 2,386 (99.4%) phones have been distributed. 1,194 (50.1%) were installed with the ParentApp intervention and 1,192 (49.9%) were installed with the control WASHApp. 68/80 groups have also completed the 12-week intervention (34/40 control groups (85%); 34/40 intervention groups (85%). Interaction with the ParentApp intervention content is high, with 83% of participants having engaged with two-thirds or more of the modules.

Several fieldwork and research activities are planned for 2024. A 12-month follow-up for the feasibility pilot study and qualitative interviews will begin in January. Ethical amendments for sibling exploratory surveys due to be distributed in February/March have been approved by University of Oxford. Between February-August, the team will interview additional siblings/adolescents living with RCT caregivers using the same survey to ascertain wider intervention impact in approximately 50% of sample households. Additionally, a ParentApp partner workshop is planned for March to reflect on progress made in the RCT, early pre/post test findings, and a strategy for 2024/2025 outputs and dissemination. Finally, a 12-month follow-up survey for the RCT is due to begin in August 2024. 

With regards to policy engagement, the team finalised a strategic roadmap for scaling parenting programmes for the prevention of violence against children. Key achievements from Phase 1 of the team’s activities are as follows:

  • Policy Review and Environment Analysis

  • Systematic Review of Parenting Interventions

  • Stakeholder mapping and engagement, including key informant interviews and regional level meetings in Mwanza and Shinyanga

  • National Stakeholders Meeting in Dodoma

  • Scaling labs with Government, NGOs, INGOs and CSOs

  • Tanzania Parenting consortium formed & TOR drafted (awaiting approval)

Update goes here

Fieldwork and implementation of the randomised controlled trial (RCT) continues to progress well and a strong partnership between the research team and the participating community has aided engagement. 72. 5% of baseline data collection is now complete, with caregiver interviews conducted for 1,734 individuals. 1,394 caregivers have been onboarded for the 12 week ParentApp and control WASHapp intervention, with 12 clusters due to complete the intervention in the first week of August. The team are also finalising a 1-month post-test follow-up survey for distribution to control group participants in the third week of August and to intervention participants in the first week of September. As part of the National Institute of Medical Research’s policy engagement on parenting interventions in Tanzania, the team met with stakeholders working on parenting and prevention of VAC at the 7th annual learning convention on prevention of VAC in Kampala, East Africa on 13 July. Other recent activities include parenting intervention scaling labs (26-28 July). 
 

Reporting by Ashlin Simpson

 

The study team has made significant progress in community engagement, participant screening, and baseline survey interviews, and the study was well received by communities. The first study clusters were randomised on 10 May and participants onboarded to the intervention or control group on 11 May. So far, 864 participants have been given phones and are currently enrolled in the programme on either the intervention app or the control app. The study team has successfully completed community sensitisation, introductory meetings, participant screening, and baseline survey interviews across 36 clusters. A total of 1,198 individuals were screened for eligibility, and out of those, 1,180 were found eligible to participate in the study. Out of the eligible participants, 892 individuals provided their consent to take part in the study. Caregiver interviews were conducted with 1079 individuals, and teen interviews were conducted with 1056 participants. The gender distribution of the participants is as follows - male: 235; female: 835; undefined: 15. One notable challenge was the impact of end-of-term examinations on the number of teen interviews conducted. Due to the exams, some teens were unavailable or unable to participate, resulting in a lower number of interviews conducted with this group.

Reporting by Ashlin Simpson

The ParentApp for Teens randomised controlled trial has officially started! Baseline data collection started in mid-April reaching ~300 caregivers and adolescents by the end of April. Even more exciting is having the 2800 low-cost smartphones delivered to the NIMR office in Mwanza. The facilitators and RAs held a training session with the phones to simulate the onboarding process and correct the process where needed, in preparation for the first randomisation and participant onboarding to take place in early May.

Concurrently, the team has been working through data analysis from the pilot and optimisation phases and will be presenting preliminary findings at this year's ISPCAN conference, as well as to the wider GPI community. Policy engagement is ongoing with the NIMR team leading communications and relationships with government, UNICEF Tanzania and other stakeholders working on parenting interventions and prevention of violence against children in Tanzania.

The tech and digital delivery teams started work on four additional programme modules which will be added to the App, the Learning Through Play, Sexual Reproductive Health, and Sexual Violence Prevention modules will be released in August this year.

Reporting by Ashlin Simpson

In March, the ParentApp for Teens (10-17) in Tanzania team made significant progress towards implementing the RCT. They registered the trial with Open Science Framework and completed a rigorous implementation review process with all teams, including NIMR, ICS, CWBSA, INNODEMS, UCT and Oxford team. Based on feedback from the recently completed piloting and optimisation studies, and made necessary changes to the implementation plan for the RCT. NIMR also held a successful meeting with UNICEF, who have expressed interest in the project. 

Unfortunately, there were some delays in March due to an outbreak of the Marburg virus in Tanzania and a delay in getting the phones delivered. As a result, they have moved baseline data collection and onboarding sessions to mid-April. However, this delay provided us with an opportunity to update SOPs, conduct additional training sessions with facilitators and RAs and refine research tools before going into the field. Training and implementation partner, CWBSA, visited Tanzania to conduct in-person training and provide on-the-ground support to facilitators. Team members from UCT and INNODEMS also visited Tanzania to provide additional support at the start of the RCT. 

The team welcomes independent M&E officer, Stivin Mwakakeke, who will be supporting the monitoring of implementation and collection of process data during the trial. Both the control and intervention apps, WASH and ParentApp, have been updated and released on the PlayStore in Tanzania. 

Furthermore, thematic analysis of Learning Through Play (LTP) focus group discussions data were completed and co-development of activities with caregivers have been drafted and are currently being co-edited with caregivers and teens from a Pan-African sample. These activities will be adapted and included in a future release of ParentApp for Teens.
 

Reported by Ashlin Simpson

Over the past month, early data from the optimisation phase and pilot phase has been used to update the app for the randomised control trial (RCT).

These changes include increasing male characters in the app images, using the non-sequential modular version of the app, meaning that all modules are open and app users can select which modules they want to engage with, and lastly, using human characters instead of the blue blob characters used in earlier versions.

The RCT version of ParentApp is currently being tested by research assistants in Tanzania ahead of the final app release on 15 March. The app will be handed over to the first group of study participants from 20 March. Two implementation workshops were held with our implementation partners, ICS and CWBSA. These workshops were used to improve implementation processes for the RCT, based on learnings from the previous phases of the project. These workshops resulted in detailed standard operating procedures (SOPs) for various parts of the project. Simultaneously NIMR in Tanzania were conducting training sessions with the RAs who are going into the field from 13 March.

Furthermore, the team has made progress on the randomization procedure and submitted ethics amendments. They have also hired an interim data officer, Joseph Kawa, to help with data management planning.

2022

Reporting by Ashlin Simpson

  Work continues apace on ParentApp for teens in Tanzania, with the piloting phase now completed. Preliminary data analysis from the piloting phase is showing successful intervention change across all but one of the outcomes. Qualitative data analysis is ongoing. Optimisation is well underway, with 613 Participants completing the ParentApp workshops and all participants are expected to complete the programme in March 2023. The preliminary Optimisation results are being used to inform delivery of the intervention in the RCT.

The team is now finalising the implementation plan for the RCT using data and learnings from the Pilot and Optimization phase. The research team in Tanzania is nearing completion of community sensitisation and are recruiting and training RAs ahead of baseline data collection which is scheduled to start at the end of February.

Reporting by Ashlin Simpson

 

September 2022
 

There have been some exciting developments for ParentApp for Teens in September, with baseline data collection being completed for the pilot study. 101 users were onboarded and are using the app with post-test data collection and qualitative interviews to begin shortly. Additionally, the trial registration for ParentApp’s optimisation study, a cluster randomised factorial trial, was approved with the Pan African Clinical Trial Registry and final preparations for the study are underway. 

ParentApp Research Officer Lauren Baerecke also presented at the Sexual Violence Research Initiative Forum in Cancun, Mexico on 22 September. Her presentation titled ‘A parenting app to prevent child sexual abuse and family violence: early learnings and future directions’ was well received with dynamic audience engagement.

October 2022
 

New skin for ParentApp

We are excited to announce that ParentApp for Teens has released the new skin of ParentApp! There are two key differences between this version of the app and the previous, starting with the way the workshops are structured. In this version of the app, workshops are in a modular format which allows the user to pick any of the 12 workshop modules as opposed to a weekly format where each workshop needs to be completed before moving on to the next workshop topic. The second big change is the move away from the blue blob characters to more human-like characters. 

Piloting: The team has completed qualitative data collection with the users of the app who showed low engagement, and further qualitative data collection continues with those who have engaged well with the app. Post-test surveys are well underway with piloting participants, with 95% of users on the last session of the programme. 

Optimisation: One of our trainers from CWBSA was able to conduct an in-person training in preparation for the Optimisation Study taking place in Tanzania. The facilitators were very happy to have the training in-person and to have Sussie with them. The training went incredibly well and provided further insight and critical in-depth feedback from the field. Optimisation study recruitment has begun and onboarding for participants is ongoing in Mwanza. Onboarding for participants using the first skin is complete, and recruitment for participants who will be using the new modular skin continues for the rest of this month. The Protocol manuscript for the Optimisation phase has been submitted for publishing. 

Trial: The Oxford ethics application was submitted and we’ve already received feedback. We are expecting to submit the Tanzania ethics application within the next week, followed by the UCT ethics application. NIMR has hired two new staff, Mr Gervas Onduru, a postdoctoral Researcher, and Ms Kiya Nyalali, a doctoral student. 

 

November 2022
 

Ending our year off on a high note, we have now completed qualitative data collection for our pilot, and over 500 participants have installed ParentApp for the upcoming RCT.

Piloting: Qualitative data collection is now complete, with  22 pilot participants in Mwanza having been interviewed. Transcription and analysis will continue early next year. Post-test surveys with piloting participants who have completed the last session of the programme are almost complete. A mid-term review of implementation has been held where all partners shared successes, challenges  and learnings - which we will take into consideration as we move into the next phase of the RCT.

Optimisation: Two of our research team had a successful fieldwork visit to Tanzania.
Over 500 participants, in 16 clusters, have successfully installed ParentApp for Teens on their mobile device. Recruitment is ongoing and programme delivery is planned to begin in the near future. 

Trial: Both Oxford and Tanzania ethics applications have been submitted and awaiting feedback, thereafter the UCT ethics application will be submitted.